Pathophysiology of Anorectal Disorders

肛门直肠疾病的病理生理学

• 批准号: 10452611
• 负责人: ADIL E. BHARUCHA
• 金额: $ 38.66万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452611
• 关键词: Abdomen; Abdominal Muscles; Abnormal coordination; Address; Anus; Barium; Biofeedback Training; Chronic; Constipation; Controlled Clinical Trials; Data; Defecation; Defecography; Diagnosis; Diagnostic tests; Disease; Feces; Female; Floor; Fluoroscopy; Functional disorder; Grant; Human; Image; Impairment; Intestines; Knowledge; Lateral; Left; Magnetic Resonance Imaging; Manometry; Measurement; Measures; Motion; Muscle; Patient Care; Patients; Pelvic floor structure; Persons; Phase; Positioning Attribute; Preparation; Process; Randomized; Rectum; Relaxation; Resolution; Rest; Role; Symptoms; Test Result; Testing; Time; Valsalva Maneuver; Woman; abdominal wall; anorectal disorder; base; design; foot; improved; innovation; insight; male; men; multidisciplinary; preservation; pressure; prevent; rectal; sphincter ani muscle structure; symptomatic improvement; ultrasound

PROJECT SUMMARY/ABSTRACT Defecation is a viscerosomatic process that requires increased rectal pressure coordinated with anal sphincter and pelvic floor relaxation. Defecatory disorders (DD) are defined by symptoms and objective features of impaired defecation. Our understanding of normal and disordered defecation are derived either from measurements of pressures (high-resolution manometry [HRM]) or emptying (defecography, rectal balloon expulsion test), but never both. HRM is usually conducted in the left lateral position with an empty rectum. This may partly explain why the rectoanal gradient (rectal – anal pressure) during evacuation is negative, even in most asymptomatic people, which undermines our concept of the mechanisms of normal defecation. Among patients, results of these tests are often inconsistent, hindering the diagnosis of DD. Excessive straining and “maladaptive” pelvic floor contraction during defecation is implicated to cause DD. However, abdominal wall motion during defecation and its coordination with pelvic floor motion have not been studied in healthy people or those with DD. Finally, even in controlled clinical trials, pelvic floor biofeedback therapy, the cornerstone of managing DD, only benefits 60% of DD patients. This treatment is not widely available or reimbursable; therefore additional therapies are necessary. Each study is designed to improve patient care in humans. Specific Aim 1: Address fundamental gaps in our knowledge of the mechanisms of normal and disordered defecation and the diagnosis of DD: 1a) Redefine the phases of normal evacuation using manodefecography; 1b) Identify the primary causes of DD in men versus women. Recto anal pressures and evacuation will be measured with HRM, barium, and MR manodefecography in 120 male and female healthy controls and 120 male and female DD patients. Specific Aim 2: Role of abdominal wall motion in normal and disordered defecation: 2a) Evaluate abdominopelvic coordination during defecation in healthy and DD women; 2b) Evaluate abdominopelvic coordination during defecation before and after biofeedback therapy. Abdominal wall motion and rectoanal pressures will be evaluated at rest and during various maneuvers, including simulated evacuation, in 30 healthy women and 60 women with DD. Specific Aim 3: Incorporating these concepts to manage DD: 3a) To assess the effects of a footstool on recto- anal functions in DD; 3b) To assess the symptoms in DD. Recto anal pressures and emptying as well as bowel symptoms will be evaluated before and after 85 female DD patients are randomized to a footstool. A multi-disciplinary collaborative team will apply innovative approaches to address these hypotheses in a highly refined manner.

项目摘要/摘要 排便是一个内脏的过程，需要与肛门括约肌协调的直肠压力增加 和骨盆底放松。缺乏障碍（DD）由符号和客观特征定义 排便受损。我们对正常和无序排便的理解是从 压力测量（高分辨率测压[HRM]）或排空（Defecography，直肠气球 驱逐测试），但绝不是两者兼而有之。 HRM通常用空直肠在左侧位置进行。这 可以部分解释为什么撤离期间直肠梯度（直肠 - 肛门压）为负，即使在 大多数不对称的人，都破坏了我们对正常定义机制的概念。之中 患者，这些测试的结果通常不一致，阻碍了DD的诊断。过度紧张和 排便过程中的“适应不良”骨盆底收缩涉及引起DD。但是，腹壁 排便期间的运动及其与骨盆底运动的协调尚未研究健康的人 或那些具有DD的人。最后，即使在对照临床试验中，骨盆底生物反馈疗法也是 管理DD，只有60％的DD患者受益。这种治疗无法广泛使用或可报销； 因此，需要其他疗法。每项研究旨在改善人类的患者护理。 特定目的1：解决我们对正常和无序机制的知识中的基本差距 DD的排便和诊断：1a）使用ManodeFecography重新定义正常疏散的阶段； 1b）确定男性与女性中DD的主要原因。 将使用HRM，钡和MR ManodeFecography测量直肠肛门压力和疏散 男性和女性健康对照以及120名男性和女性DD患者。 特定目标2：腹壁运动在正常和无序排便中的作用：2a）评估 健康和DD妇女排便期间的腹部协调； 2b）评估腹部 生物反馈治疗前后排便期间的协调。 腹壁运动和直立压力将在静止和各种操作中评估， 包括模拟疏散，包括30名健康女性和60名DD女性。 特定目的3：将这些概念纳入管理DD：3A），以评估脚凳对正直的影响 DD中的肛门功能； 3B）评估DD中的症状。 在85名女性之前和之后，将评估直肠肛门压力和排空以及排尿症状 DD患者被随机分配到脚凳上。一个多学科的合作团队将采用创新 以高度精致的方式解决这些假设的方法。